FEVERS WITHOUT PHYSICAL SIGNS


FEVERS WITHOUT PHYSICAL SIGNS.
Short notes of a clinic delivered in K.E.M. Hospital, Parel. Bombay.

(L.D. Dhaw…


FEVERS WITHOUT PHYSICAL SIGNS.

Cause:.

1. Toxins of microbic origin.

2. Instability of the heat-regulating mechanism as found in:.

(a) the neurotic patient,.

(b) one recovered from long febrile illness,.

(c) the chronic alcoholic, and.

(d) the morphia addict.

3. Metabolic upsets as found in:.

(a) acute gout.

(b) acute stage of Graves Diseases,.

(c) a premenstrual period in some cases,.

(d) serum sickness,.

(e) rickets,.

(f) heat stroke,.

(g) severe haemorrhage: (i) haematemesis. (ii) Melaena,. (ii) post-partum haemorrhage,.

(h) Addisons anemia,. (i) cirrhosis of liver,.

(j) nephritis, and.

(k) rapidly growing neoplasms, malignant and nonmalignant and nonmalignant, and those, and those undergoing necrosis.

SCHEME OF INQUIRY IN A CASE OF PYREXIA WITH OUT PHYSICAL SIGNS:.

1. Pulse.

2. Respiration,.

3. Temperature,.

4. Special points in the patients history,.

5. Absolute and differential count of white blood cells.

Pulse: not exceeding 90: coli typhoid group:.

Exceeding 90: scarlet fever and T.B. infection.

Respiration: normally, increase of 2 or 3 per degree of fever; when more, suggests respiratory disease.

Temperature: duration & type.

1. Fever of short duration:.

acute exanthemata..

2. Fevers of long duration:.

(a) Tuberculosis,.

(b) Typhoid group infection,.

(c) Septic endocarditis,.

(d) Lymphadenoma,.

(e) Coliform infection, and.

(f) Otitis Medica in a child.

3. Continued type of temperature:.

(a) Pneumonia: physical signs are wanting if associated with emphysema.

(b) Influenza: fever not more than five days.

(c) Typhoid: temperature, step-ladder fashion; relapses even after four weeks.

4. Relapsing type of temperature:.

(a) Rat-bite fever, 3 to 4 weeks of incubation,.

(b) Lymphadenoma,.

(c) Mediterranean fever, and.

(d) Relapsing fever.

5. Periodic type of fever:.

(a) Malaria,.

(b) i. Meningococcus infection.,

Reverse type of temperature.

(D) iii. Typhoid fever,.

(e) i. Septicaemia,.

(f) ii. Kala-azar.

Two spike in the chart of temperature, in 24 hours.

(g) ii. Kala-azar.

(g) Pyaemia: Rigors in the course of pyrexia.

6. Regular remittent type of fever:.

Active tuberculosis of:.

(a) Pleura,.

(b) Peritoneum, and.

When not complicated by secondary infection.

(c) Lungs,.

7. Regular intermittent fever:.

(a) Malaria,.

(b) Pyogenic infection.

SPECIAL POINTS IN THE PATIENTS HISTORY:.

History preceding the onset:.

(a) Where has he been? area endemic or epidemic.

(b) State of health before fever:.

1. Nephritic-metabolic fever;.

2. Valvular disease-malignant endocarditis;.

3. Cirrhosis of liver-metabolic fever or T.B. infection.

4. Malaria-easy rise of temperature;.

5. Amoebic dysentery-hepatitis;.

6. Anaemia, dyspnoea, pleurisy, haemoptysis- T.B. infection of lungs.

(c) Recent surgical operations:.

1. Remote areas-the seat of infection being subphrenic region, pleura, liver: after abdominal operations;.

2. Sinuses-meninges-veins, are the seat of infection after operations on ear and nose;.

3. Serum administration-seven to ten days before fever.

COUNT OF W. B. Cs.

i. High leucocytosis:.

1. Bone inflammation-osteomyelitis;.

2. Perineal tissue ischeo-rectal abscess;.

3. Sinus infection.

ii. Leucopenia:.

1. Typhoid-paratyphoid infections,.

2. Measles,.

3. Malaria,.

4. Mediterranean fever,.

5. Influenza,.

6. General tuberculosis, not involving serous membrane.

iii. Differential Count:.

1. Leucoid count, in coccal infection;.

2. Lymphoid count, in bacillary infection;.

3. When bacillary infection is superimposed by coccal infection, the count is of the leucoid type.

L. D. Dhawale